Chest
ReviewsThrombolytic Therapy of Left-Sided Prosthetic Valve Thrombosis
Section snippets
Patients
Both patients underwent cinefluoroscopy to demonstrate valvular leaflet obstruction. Measurements of excursion angles were performed as previously recommended.6 Repeated cinefluoroscopy was performed within 24 h of therapy. Visualization of thrombus was confirmed by transesophageal echocardiography (TEE) in each patient. Confirmation of improved valve function was performed by Doppler echocardiography within 24 h of therapy. Urokinase was administered intravenously with a bolus dose of 4,400
CASE 1
A 76-year-old woman underwent aortic valve replacement with a 21-mm valve (St. Jude Medical Valve) for severe postrheumatic aortic stenosis. Owing to the patient's general debility, the postoperative course was prolonged and she required transfer to a convalescent center for rehabilitation. Six weeks after surgery, she developed acute right calf pain and lower leg numbness. A later arterial scan revealed an occluded right superficial femoral artery and suggested a previous embolic event. The
Discussion
The administration of thrombolytic agents has been recommended as initial therapy for prosthetic valves with thrombosis in the tricuspid position. However, caution has been advised in regards to left-sided valve thrombosis because of the concern of cerebral and peripheral thromboembolism. Because of the low incidence of PVT, random comparative evaluation of medical and surgical modalities of treatment has not been performed. Several clinical reports have suggested clinical efficacy of
Acknowledgment
We gratefully acknowledge the secretarial assistance of Susan Freppert in the preparation of this manuscript.
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Prosthetic heart valve thrombosis treated with low-dose slow-infusion fibrinolytic therapy
2015, Journal of Cardiology CasesGuidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: A report from the american society of echocardiography
2015, Journal of the American Society of EchocardiographyComparison of different TEE-guided thrombolytic regimens for prosthetic valve thrombosis: The TROIA trial
2013, JACC: Cardiovascular ImagingCitation Excerpt :The results of our study indicate that although the success rate for thrombolysis was similar among Groups I through V, the Group V regimen was superior to the other 4 regimens because it was associated with reduced complications and mortality (Fig. 1). The overall success rate (85.9%) in our study is well within the range of previous publications, although there has been no uniformity of treatment regimens or definition of success (10,11,14–18,27,28). Moreover, the success rates were similar in the 5 groups.
Transesophageal Echocardiography Improves Risk Assessment of Thrombolysis of Prosthetic Valve Thrombosis: Results of the International PRO-TEE Registry
2004, Journal of the American College of CardiologyCitation Excerpt :Thrombolysis of PVT has emerged as an alternative to surgery by circumventing the risks of re-operation (4)but carries inherent complications. In recent reviews (15,27)and in a series of 110 patients by Gupta et al. (18), hemodynamic improvement was seen in the majority (>70%) of cases, with a complication rate of 12% to 24%, and a death rate of 6% to 10%. In the study by Gupta et al. (18), atrial fibrillation was reported as a risk for embolic complication.
Prosthetic valve thrombosis - Case report and literature review
2003, European Journal of Internal Medicine